Pituitary Tumors: Impact on Health and Treatment Options

Q: Pituitary Tumors: Impact on Health and Treatment Options

Hello： Based on your description, you mentioned that the issue with the pituitary tumor was noted three years ago. <br>If you are concerned about the tumor enlarging, a visual field test can be arranged. <br>If the visual field test shows an increase in defects, an MRI can be sch

Pituitary tumor

The father is 77 years old and has heart disease (arrhythmia, mitral valve insufficiency).
According to the cardiologist, his heart function is only at 20%.
His kidney function is poor but has not yet reached the stage of requiring dialysis.
Currently, he can walk independently but needs to rest after about 3 minutes.
For many years, he has experienced vomiting and headaches, and an MRI confirmed a non-functional pituitary tumor, which has caused vision impairment.
He refuses surgery or chemotherapy and has not received any active treatment for this tumor.
The most recent MRI was done in January 2015, showing the tumor is approximately 3.2 cm in size.
At the end of April this year, he was admitted to the intensive care unit due to heart failure and was discharged in mid-May.
After discharge, he has been on the same heart medications as before, but he has gradually developed the following symptoms: 1.
Frequent dizziness, nausea (sometimes leading to vomiting), and headaches that improve slightly with pain medication.
This phenomenon used to occur and resolve in 2-3 days, but now it has persisted since his discharge.
2.
A constant feeling of fatigue and excessive sleeping, sometimes claiming to see ghosts.
3.
Although he does not have diabetes, his blood sugar has been very unstable since his hospitalization, often experiencing hypoglycemia, with the lowest readings being 40-50.
After eating, his levels return to 90-110.

I would like to ask if the above symptoms could be due to endocrine abnormalities caused by the pituitary tumor? Given his heart condition, is surgery a viable treatment option? If surgery is not suitable, can medication improve the aforementioned conditions?

Rebecca, 40~49 year old female. Ask Date: 2018/06/10

Dr. Jiang Junyi reply Neurology

Hello: Based on your description, you mentioned that the issue with the pituitary tumor was noted three years ago.
If you are concerned about the tumor enlarging, a visual field test can be arranged.
If the visual field test shows an increase in defects, an MRI can be scheduled for further evaluation.
Regarding endocrine abnormalities, blood tests can be arranged to rule them out.
However, the issue of hypoglycemia may need to consider renal function; as renal function deteriorates, drug metabolism may slow down, potentially leading to hypoglycemia.
Additionally, the presence of glycogen in the body helps maintain stable blood sugar levels.
With a decrease in muscle mass and the occurrence of liver cirrhosis, glycogen stores may diminish, which could result in hypoglycemia.
The dizziness, nausea, and fatigue you mentioned may be related to reduced cerebral blood flow, as heart failure medications may strictly control fluid levels, leading to insufficient blood flow to the brain.
It could also be symptoms related to the accumulation of uremic toxins.
I recommend discussing further evaluation and treatment with a neurologist.
Wishing you and your mother good health, peace, and joy.
Dr.
Jiang, Taoyuan Medical Center, cares about you.

Reply Date: 2018/06/10

More Info

Understanding pituitary tumors, particularly in the context of your father's health situation, is crucial for managing his symptoms and overall well-being. Pituitary tumors, such as non-functional adenomas, can significantly impact health due to their location and potential effects on hormone production and surrounding structures, including the optic nerves.

Impact on Health
1. Hormonal Imbalance: Although your father's tumor is classified as non-functional, it can still exert pressure on the pituitary gland and surrounding tissues, potentially leading to hormonal imbalances. The pituitary gland is responsible for regulating various hormones that control metabolism, stress response, growth, and reproductive functions. Disruption in hormone levels can lead to symptoms such as fatigue, nausea, and changes in blood sugar levels.

2. Vision Problems: The tumor's size (3.2 cm) and its location can compress the optic chiasm, leading to vision problems, which you have noted in your father's case. This compression can cause visual field defects, which may worsen over time if the tumor continues to grow.

3. Neurological Symptoms: Symptoms such as persistent headaches, dizziness, and nausea can be attributed to increased intracranial pressure or direct effects of the tumor on brain structures. These symptoms can be exacerbated by your father's existing heart condition and overall health status.

4. Cardiovascular and Renal Health: Given your father's heart condition (with only 20% heart function) and compromised renal function, any surgical intervention poses significant risks. His heart's inability to handle stress could complicate recovery from surgery, making it essential to weigh the benefits against the risks carefully.

Treatment Options
1. Surgical Intervention: Surgery is often the first-line treatment for symptomatic pituitary tumors, especially if they are causing significant neurological deficits or vision problems. However, in your father's case, the risks associated with surgery, given his heart condition and overall frailty, may outweigh the potential benefits. A thorough evaluation by a neurosurgeon, considering his cardiac status, is essential to determine if surgery is feasible.

2. Medication: If surgery is not an option, medical management may be considered. While non-functional tumors do not typically respond to chemotherapy, medications can help manage symptoms. For instance, if there is any hormonal imbalance, hormone replacement therapy or medications to stabilize blood sugar levels may be beneficial. Close monitoring of his blood sugar levels is crucial, especially given the recent fluctuations and episodes of hypoglycemia.

3. Regular Monitoring: Given the tumor's size and your father's symptoms, regular follow-up with MRI scans is necessary to monitor any changes in the tumor's size and assess the need for intervention. This is particularly important as his symptoms persist.

4. Supportive Care: Addressing your father's quality of life is vital. This may include pain management, nutritional support, and possibly physical therapy to help him maintain mobility and independence as much as possible.

Conclusion
In summary, your father's symptoms could indeed be related to the pituitary tumor, particularly if there are hormonal imbalances or increased intracranial pressure. Given his complex medical history, a multidisciplinary approach involving endocrinologists, neurosurgeons, and cardiologists is essential for optimizing his care. It is crucial to have open discussions with his healthcare team about the risks and benefits of potential treatments, including surgery and medication, to make informed decisions that align with his health goals and quality of life.

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